Are Root-Supported Overdentures Still an Alternative to Implant-Supported Overdentures? A Scoping Review.

PURPOSE: To compare the outcomes of prosthodontic treatment for subjects wearing a complete maxillary denture opposing a root-supported mandibular overdenture (RSO) or an implant-supported mandibular overdenture (ISO). METHODS: A literature search was performed in seven electronic databases: MEDLINE via PubMed interface, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, and AgeLine. The search terms were developed by the primary investigators and the health sciences librarian, who then started with PubMed and adapted the original search strategy for the other databases. Included articles were those that compared the outcomes for mandibular RSOs and those with ISOs, for persons wearing a maxillary complete denture. RESULTS: Seven articles were included in the review. There were limitations in this review because of small sample sizes, short study durations, and different methodologies. Also, no comparative studies were identified for clinically important outcomes, such as survival rates of abutments, prosthodontics/maintenance problems, and longitudinal cost of care. For prosthodontic complications, patient satisfaction, and ability to clean, no differences were reported. For oral tactile sensibility, RSOs presented significantly improved sensibility, whereas ISOs had higher maximum bite force capability, but the difference was not statistically significant, except when subjects had a cross-bite or a lingualized occlusion. CONCLUSIONS: The results of this scoping review were not conclusive, except for maximum bite force, where ISOs seem to perform better than RSOs by the measured criteria. ISOs had higher survival rates than RSOs, and required less maintenance, but were more expensive. It was disappointing to find so few studies comparing these clinical treatment modalities, which suggests that either treatment may be clinically acceptable and depends upon a shared decision between patients and their dentists.

Longitudinal Assessment of Denture Maintenance Needs in an Overdenture Population.

PURPOSE: To evaluate the longitudinal denture maintenance needs of a tooth-supported overdenture population. MATERIALS AND METHODS: This prospective cohort study was composed of patients who had received tooth-supported overdentures from 1974 to 1994 in the Department of Prosthodontics, University of Iowa. There were 272 persons with 662 abutments who fulfilled the inclusion criteria. To simplify analysis and reduce the number of confounding variables, only those participants wearing complete maxillary dentures and opposing complete mandibular overdentures supported by teeth #22 and #27 were included in this analysis. The denture maintenance needs of these participants were identified and related to age, gender, length of time wearing overdentures, number of medications, and denture-wearing habits. Descriptive statistics and bivariate analyses were used for the statistical analysis (α = 0.05). RESULTS: Of the 91 participants (mean age = 59.5 ± 10.1 years; 63.7% male) who fulfilled the inclusion criteria at baseline, 48.4% took 1 to 3 medications daily, and 84.6% wore their dentures day and night. The percentages of participants who needed one or more of the following denture treatments were: 91.2% denture base adjustments, 76.9% laboratory processed relines, 61.5% denture remakes, 33% laboratory remount and occlusal adjustment, 22% repaired bases, and 19.8% needed denture teeth replaced. Bivariate analyses indicated that participants who were 65 years and older needed more denture adjustments than patients younger than 65 years (p = 0.0343). Participants who had worn overdentures for more than 5 years were more likely to require denture remakes (p = 0.0304). Participants who wore their dentures only during the day were less likely to require repairs (p = 0.0403). Participants who did not take any medications were significantly less likely to require denture base repairs (p = 0.0258). For the 35 participants who returned for recalls at all 4 time points, males were more likely to need denture teeth repaired or replaced (p = 0.0335) and those aged 50 to 64 were more likely to need 2 or more adjustments (p = 0.0311). No overdenture abutments were lost by the participants in this study. CONCLUSIONS: According to the results of this study, age, medication usage, denture-wearing habits, and age of the overdentures were significant factors associated with denture maintenance needs. Persons wearing overdentures need regular recalls, because they have continuing maintenance needs.

The Extent and Scope of Prosthodontic Practice in Iowa.

PURPOSE: The purpose of this questionnaire was to ask general dentists in private practice in the state of Iowa about the extent and scope of their prosthodontic practice. MATERIALS AND METHODS: A 22-item questionnaire was developed and tested on 5 general dentists. The Iowa Dental Association agreed to electronically distribute the survey to all general practice dentists in their database. After three rounds, a total of 289 responses were received from the 996 general dentists in the database. RESULTS: The average age of the respondents was 50.3 ± 13.2 years (range 28 to 78 years), and 56.3% were in solo practice. The respondents stated that 68.1% had made at least one set of complete dentures and 88.9% had made a removable partial denture (RPD) in the last 3 months, while 76.4% had restored a least one implant in the last 3 months and 11.6% had surgically placed one. Nearly 20% of the respondents had a digital impression scanner in their office. There was a statistically significant difference between the dentists who had made complete dentures in the past 3 months and those who had not with regard to age, gender, and years in practice (p < 0.05 for all instances). No significant difference was found between the general dentists who had made an RPD in the past 3 months and those who had not. Compared to their counterparts, general dentists who had an AEGD or GPR training (p = 0.0312), whose primary practices were in cities of 50,000+ (p = 0.0065), or had a digital scanner (p = 0.0062) and a CAD/CAM milling machine (p = 0.0504) in their office were more likely to have restored an implant in the last 3 months. Furthermore, the general dentists who had surgically placed an implant in the last 3 months were more likely to be male (p = 0.0301) or have a digital impression scanner (p < 0.0001) and/or a CAD/CAM milling machine (p = 0.0007) in their office. CONCLUSIONS: The majority of general dentists in this survey are still making complete and partial removable dentures, and a majority is using implants, while only a minority is surgically placing them. PRACTICAL  IMPLICATIONS: Although Iowa general dentists are carrying out sophisticated procedures such as implant placement and restoring implants, as well as using digital technology, there is still a need for removable prosthodontic services in their practices. Therefore, these skills will still need to be taught in dental school.

Curriculum content in geriatric dentistry in USA dental schools.

OBJECTIVES: The aim of this study was to re-examine the teaching of geriatric dentistry in the USA dental schools, to identify curriculum content and compare the findings to previous reports. METHODS: All dental schools in the United States were contacted via email with a questionnaire to assess the teaching of geriatric dentistry. Non-responding schools were sent a minimum of three reminder emails to complete the survey. A statistical analysis was performed. Descriptive statistics were conducted to profile the variables of interest. Bivariate analysis was performed to explore if any of the variables were related using Fisher's exact test, non-parametric Wilcoxon rank-sum test and the Kruskal-Wallis test. RESULTS: Fifty-six of the 67 dental schools completed the questionnaire. Geriatric dentistry was taught in all dental schools; for 92.8%, the course was compulsory. We found that 62.5% were teaching it as an independent course, 25% as an organised series of lectures and 8.9% as occasional lectures in parts of other courses. Clinically, 84.2% have some form of compulsory education in geriatric dentistry. Public schools were marginally associated with an increased interest in expanding the geriatric dentistry curriculum (P = .078). No differences were found between these variables and school location. CONCLUSIONS: Geriatric dentistry is now required in 92.8% of dental schools. The teaching of traditional topics has not changed much; however, the number of gerontological topics has increased. Clinical teaching needs to be expanded, as in only 57.1% of schools was it a requirement. The ageing imperative will require research to determine the impact of teaching on services to the geriatric community.

In vitro evaluation of the marginal integrity of CAD/CAM interim crowns.

STATEMENT OF PROBLEM: The accuracy of interim crowns made with computer-aided design and computer-aided manufacturing (CAD/CAM) systems has not been well investigated. PURPOSE: The purpose of this in vitro study was to evaluate the marginal integrity of interim crowns made by CAD/CAM compared with that of conventional polymethylmethacrylate (PMMA) crowns. MATERIAL AND METHODS: A dentoform mandibular left second premolar was prepared for a ceramic crown and scanned for the fabrication of 60 stereolithical resin dies, half of which were scanned to fabricate 15 Telio CAD-CEREC and 15 Paradigm MZ100-E4D-E4D crowns. Fifteen Caulk and 15 Jet interim crowns were made on the remaining resin dies. All crowns were cemented with Tempgrip under a 17.8-N load, thermocycled for 1000 cycles, placed in 0.5% acid fuschin for 24 hours, and embedded in epoxy resin before sectioning from the mid-buccal to mid-lingual surface. The marginal discrepancy was measured using a traveling microscope, and dye penetration was measured as a percentage of the overall length under the crown. RESULTS: The mean vertical marginal discrepancy of the conventionally made interim crowns was greater than for the CAD/CAM crowns (P=.006), while no difference was found for the horizontal component (P=.276). The mean vertical marginal discrepancy at the facial surface of the Caulk crowns was significantly greater than that of the other 3 types of interim crowns (P<.001). At the facial margin, the mean horizontal component of the Telio crowns was significantly larger than that of the other 3 types, with no difference at the lingual margins (P=.150). The mean percentage dye penetration for the Paradigm MZ100-E4D crowns was significantly greater and for Jet crowns significantly smaller than for the other 3 crowns (P<.001). However, the mean percentage dye penetration was significantly correlated with the vertical and horizontal marginal discrepancies of the Jet interim crowns at the facial surface and with the horizontal marginal discrepancies of the Caulk interim crowns at the lingual surface (P<.01 in each instance). CONCLUSIONS: A significantly smaller vertical marginal discrepancy was found with the interim crowns fabricated by CAD/CAM as compared with PMMA crowns; however, this difference was not observed for the horizontal component. The percentage dye penetration was correlated with vertical and horizontal discrepancies at the facial surface for the Jet interim crowns and with horizontal discrepancies at the lingual surface for the Caulk interim crowns.

Geriatric dentistry content in the curriculum of the dental schools in Chile.

OBJECTIVE: The purpose of this study was to identify the status of pre-doctoral geriatric dentistry education among all Chilean dental schools. BACKGROUND: Chile is one of the most rapidly ageing countries in Latin America. Consequently, specific knowledge and training on the needs of elderly populations need to be emphasised in dental schools. The current extent and methods of teaching geriatric dentistry among the dental schools in Chile are unknown. MATERIALS AND METHODS: A web-based questionnaire was developed and sent to all 19 Chilean dental schools to identify which schools had a formal programme on geriatric dentistry and ask about their format, content and type of training of the faculty who taught in the programmes. Data were analysed, and a comparison was made among the schools. RESULTS: Sixteen (84%) of the participant schools reported teaching at least some aspects of geriatric dentistry, using various methodologies, but only 7 (37%) had specific courses. Of those schools reporting a didactic content on geriatric dentistry, 71% included clinical training, either in the school's dental clinics or in an extramural service. Contents mostly included demographics of ageing, theories of ageing and medical conditions. More than half of the faculty (57%) stated that they had formal training in geriatric dentistry, 43% were trained in prosthodontics, public health or other areas. CONCLUSIONS: Although most dental schools taught geriatric dentistry, only some had a specific course. Most schools with formal courses followed the international curriculum guidelines for geriatric dentistry.

Incidence of attachment loss of canines in an overdenture population.

STATEMENT OF PROBLEM: Caries and periodontal disease are the most common cause of tooth loss in overdenture populations. Longitudinal data on attachment loss in this population have not been well reported. PURPOSE: The purpose of this longitudinal study was to measure periodontal attachment loss in overdenture abutments. MATERIAL AND METHODS: In this longitudinal overdenture study, 272 persons fulfilled all of the inclusion criteria. These persons had 662 teeth, 465 (70.2%) of which were canines. This report focused only on participants with canines who returned for 3 consecutive recalls in the 42 months of the study and included 53 persons with 116 canines. During this 42-month period, 6 teeth were extracted. Attachment loss was measured at baseline and at 6 to 18 months, 19 to 30 months, and 31 to 42 months at the mesial, distal, mid-buccal, and mid-lingual surface of each tooth, and was calculated as the combination of pocket probing depth plus height above the gingiva. Attachment loss was compared at each recall. A single examiner made all the measurements. RESULTS: At baseline, the greatest amount of loss was at the mid-buccal surface (5.43 mm), followed by the mid-lingual (4.95 mm), distal (4.41 mm), and mesial (4.35 mm) surfaces. This pattern of attachment loss did not change over the 3 time periods, except that, at the 6 to 18-month recall, the distal measurement was less than at baseline. This decrease could be due to the wear of the abutment or loss of a restoration due to caries. Attachment loss was greater on the mandibular abutments than on the maxillary abutments and could be due to the greater amount of movement of the mandibular overdenture, especially in a buccolingual direction. CONCLUSION: Attachment loss varied by arch and by site in patients who wore overdentures.

In vitro assessment of 3 dentifrices containing fluoride in preventing demineralization of overdenture abutments and root surfaces.

STATEMENT OF PROBLEM: Caries development under overdentures has been a continuing problem and requires the daily use of fluoride to prevent demineralization. PURPOSE: The purpose of this in vitro study was to compare the effectiveness of dentifrices containing tricalcium phosphate or calcium phosphosilicate in combination with fluoride to prevent the demineralization of overdenture abutments and root surfaces. MATERIAL AND METHODS: A total of 56 caries-free extracted teeth were prepared as overdenture abutments. The teeth were painted with acid-resistant varnish, leaving one 1×4-mm window on occlusal and root surfaces. The teeth were randomly divided into 4 groups: a control group treated with distilled/deionized water only, a group treated with ClinPro 5000, a group treated with ReNew, and a group treated with Prevident 5000 gel. Each tooth was subjected to a demineralizing/remineralizing cycling protocol for 12 days with the appropriate treatment products. The teeth were sectioned longitudinally through both windows. Photomicrographs were made of 3 representative sections from each tooth. A representative section was defined as one that included both windows and was cut from the part of the tooth that had the flattest surface to reduce the edge effect. The depths of the lesions were measured on representative sections from each group. A 1-way MANOVA and a 1-way ANOVA with the post hoc Tukey-Kramer test were used to evaluate the treatment effects on the criterion variables (α=.05). RESULTS: The total lesion depths of the control teeth on the occlusal surface were not statistically significantly deeper than for the 3 dentifrices (P=.7705). However, all 3 dentifrices had narrower cavitation depths than the control (mean cavitation band depth, 43.59 [ReNew] versus 37.99 [Prevident 5000 gel] versus 36.70 [ClinPro 5000] versus 246.86 [control]) (P<.001). The mean remineralization band depth for ClinPro 5000 was significantly greater than for the other 2 treatment groups (118.03 [ClinPro 5000] versus 107.80 [ReNew] versus 102.28 [Prevident 5000 gel]) (P<.001). On root surfaces, the total lesion depth for the control group was statistically significantly deeper than for the 3 dentifrices (mean total lesion depth, 150.31 [control] versus 82.05 [ReNew] versus 68.10 [ClinPro 5000] versus 56.97 [Prevident 5000 gel]) (P<.001). The data indicated that teeth treated with Prevident 5000 gel had the shallowest total lesion depth and were statistically significantly different from those treated with ReNew and ClinPro 5000. Moreover, teeth treated with ReNew were found to have the largest remineralization band depth, which was statistically significantly different compared with ClinPro 5000 and Prevident 5000 gel (mean remineralization band depth, 49.66 [ReNew] versus 36.14 [ClinPro 5000] versus 23.27 [Prevident 5000 gel]) (P<.001), but no difference was found in cavitation depth of the root lesions between the 3 dentifrices. CONCLUSIONS: The addition of tricalcium phosphate or calcium phosphosilicate to fluoride-containing dentifrices (5000 ppm) does not significantly improve their ability to prevent demineralization of the cut dentin surface of overdenture abutments. However, on root surfaces, ReNew, which contains calcium phosphosilicate, was found to improve remineralization of the lesions compared with Prevident 5000 gel or ClinPro 5000.

Prevention and nonsurgical management of dental caries over the life course for individuals with special health care needs.

Traditional approaches to caries prevention and management are unlikely to result in successful outcomes for individuals with special health care needs. Intensive prevention-oriented and minimally invasive restorative approaches have the greatest potential to address oral health disparities affecting vulnerable populations. This paper introduces readers to oral health-related issues for patients with special health care needs across the life course and outlines clinical strategies to prevent and manage caries in high-risk patients.

Treatment of an edentulous patient over 23 years showing the influence of systemic health on oral health and quality of life.

This case history follows the treatment of a 61-year-old edentulous woman over a period of 23 years. The patient was wearing complete dentures for 25 years prior to treatment, was in pain, and having difficulty eating. Many treatments were tried, including multiple soft liners, hydroxyapatite to improve her mandibular ridge, and finally an implant-supported-overdenture. However, in spite of using all the technical procedures and materials available to us at the time of treating the patient, we were unable to sustain the comfort and quality of life for this patient. This happened because of the severe resorption of her mandible, with an intolerance to occlusal loading, and the continuous deterioration of her systemic health.

The Prevention, Diagnosis, and Treatment of Rapid Oral Health Deterioration (ROHD) among Older Adults.

The world's population is aging. Older adults are at risk for multiple chronic medical problems as they age. The management of these diseases requires these people to take a variety of medications, which may have undesired side effects. These medical issues can impact oral healthcare and result in a precipitous decline in oral health. A standardized teaching model has been developed to help novice dental practitioners learn how to access and treat oral health problems in older adults. This model is called rapid oral health deterioration (ROHD) risk assessment. The model has four steps for assessment and four categories of risk. This paper describes the components of the ROHD risk assessment, and how it can be used to prevent, diagnose and treat ROHD among older adults.

Demographics and social determinants of oral health for baby boomers.

OBJECTIVE: Age cohorts such as the baby boomers are influenced by historical experiences and the socio-dental events during their lifespan. These events/experiences have impacted their health behavior and consequently, their systemic and oral health. As the baby boomer population is aging, and the majority of them are retaining some of their natural teeth for longer, only fewer are becoming edentulous. This paper discusses the demographics and the social determinants of health of the early baby boomers (1945-1955), as well as the late boomers (1956-1964). METHODS: We have used data from the literature to describe the events which might have impacted these cohorts' attitudes and expectations towards the utilization of health care and dental services. RESULTS: There are variations in the way different age groups perceive dentistry and use dental and other healthcare services, known as cohort differences. Nonetheless, because people are now keeping more of their natural teeth as they age, there is a greater demand for oral healthcare among the baby boomer generation. In order to provide specialized care that addresses their unique needs, there is a need for expanded training programs at both the undergraduate and postgraduate levels. CONCLUSION: A cohort is composed of numerous individuals whose attitudes and behaviors are shaped by their personal life experiences and broader societal trends. Consequently, any information about a particular cohort can only offer generalizations. As healthcare providers, it is important to be aware of the general characteristics of a cohort, but also exercise caution when applying them to individual patients. We should interpret these characteristics in light of each patient's unique circumstances.

A 30-year review of a geriatric dentistry teaching programme.

OBJECTIVE: To review the development of the Geriatric Dental and Special Needs Education programme at the University of Iowa over the last 30 years. BACKGROUND: The programme at Iowa evolved from a didactic elective programme taught by a single faculty person to a required didactic and clinical programme, which includes a Special Care Clinic in the dental school and a mobile unit with portable dental equipment which serves ten area nursing homes with comprehensive care. MATERIALS AND METHODS: Changes have been made in the programme over time based on formal and informal feedback from students and graduates, and we have also looked at the impact of the programme on dental services to our target population. RESULTS: The factors influencing the curriculum development are identified and discussed. CONCLUSION: As no dental schools are the same, some general applications are suggested from the Iowa experience.

Global Perspectives of Oral Health Policies and Oral Healthcare Schemes for Older Adult Populations.

The aim of this study was to present a concise summary of the oral health policies and oral healthcare schemes for older adult populations in a number of selected countries around the world. In this paper, the current and planned national/regional oral health policies and oral healthcare schemes of nine countries (Australia, Brazil, China including Hong Kong, India, Japan, Switzerland, Thailand, the United Kingdom, and the United States) are reported. Barriers and challenges in oral health promotion in terms of devising oral health policies, implementing oral health schemes, and educating the future dental workforce are discussed. In response to the aging of population, individual countries have initiated or reformed their healthcare systems and developed innovative approaches to deliver oral health services for older adults. There is a global shortage of dentists trained in geriatric dentistry. In many countries, geriatric dentistry is not formally recognized as a specialty. Education and training in geriatric dentistry is needed to produce responsive and competent dental professionals to serve the increasing number of older adults. It is expected that oral health policies and oral healthcare services will be changing and reforming in the coming decades to tackle the enduring oral health challenges of aging societies worldwide.

The development of geriatric dental education programs in Canada: an update.

The Canadian population is aging, and the oral health needs of this aging population have changed. The majority of older people are now dentate, which means that they continue to need the services of a dentist, specifically dentists who have been trained in geriatric oral health care. This paper reviews the history of geriatric training in Canada. Such training remains inadequate at both the predoctoral level and the postdoctoral or fellowship level. If geriatric or special needs dentistry were to be accepted as a specialty program, it might become more attractive as a career path for dentists.

Management of a failed mandibular staple implant: a clinical report.

A 48-year-old woman sought treatment because her staple implant-retained overdenture was no longer retentive, and the denture was worn over the abutments. After unsuccessfully attempting to move the retentive nuts along the transosseous posts of the staple implant, the posts were cut off at the level of the bone. Two endosseous implants were placed around the staple implant, and a new implant-retained overdenture was fabricated and inserted using ball attachments for retention. This article describes the treatment for this patient, who has been wearing the new dentures successfully for the past 4 years.

Cohort differences among aging populations: An update.

BACKGROUND: The US population is aging. Most older adults are retaining their natural teeth for longer, and fewer are becoming edentulous. METHODS: Among people 65 years and older, there is greater heterogeneity than at any other time in the life cycle because these cohorts are influenced by historical experiences and the sociodental events during their life spans. These events and experiences have affected their health behaviors and, consequently, their systemic and oral health. This article is an update on 2 previous articles that described birth cohorts spanning from 1900 through 1945, whereas this article describes 5 specific cohorts born from 1920 through 1980. RESULTS: The authors used data from the literature to describe the historical and socioeconomic influences, as well as the key events in the history of dentistry, that have affected each of these cohorts' attitudes and expectations toward the use of health care and dental care services. CONCLUSIONS: The authors identified cohort differences regarding health behaviors, which included attitudes toward dentistry and dental care service use. PRACTICAL IMPLICATIONS: Dentists should be aware of cohort differences in regard to dental care service use, in addition to modifiers that are specific to each patient, to offer the most customized and age-appropriate oral health care.

Geriatric Dentistry Curriculum in Six Continents.

The purpose of this study was to examine the presence of geriatric dentistry (GD) in the curricula of worldwide dental schools, and to identify and compare their curriculum content. Eighty-three dental schools (16.4% response rate), from 24 countries, in six continents, completed a 25-item online questionnaire, to assess their GD curriculum, and were included in the study. GD was a mandatory course in 56 dental schools (67.5%), an independent subject in 14 schools (16.9%), and was taught as a series of lectures in 31 schools (37.4%). Clinically, 56 dental schools (67.5%) had some form of mandatory education in GD. The type of school, location and method of presentation were not associated with greater interest in expanding their curriculum in GD (p = 0.256, p = 0.276, and p = 0.919, respectively, using the Chi-square test). We found GD is a curriculum requirement in most of the surveyed dental schools and is becoming more common among dental school curricula. This survey is the first study to present data from dental schools from all continents, using a web-based survey which is a resourceful, less-expensive tool to gather data.